Feds Move to Protect Due Process Rights for Medicaid Providers

Four federal lawmakers from New Mexico – Sen. Martin Heinrich, Sen. Tom Udall, Rep. Ben Ray Luján and Rep. Michelle Lujan Grisham – filed a bill last week to guarantee due process rights to Medicaid providers across the country who are being investigated for Medicaid fraud.

Under the legislation, individuals being investigated will be allowed to continue treatment for their patients and be paid for that treatment while the investigation is ongoing.

Medicaid Program Enhancement Act of 2016

The Medicaid Program Integrity Enhancement Act of 2016 is, per the Home Health Care News, “designed to prevent unnecessary payment suspensions by requiring a Medicaid agency to consult with a state attorney general on the credibility of allegations before suspending payments. Additionally, the bill is meant to protect beneficiary access to care by requiring a state to consider the effect a payment suspension might have on beneficiary access to care, before withholding payments. The bill also ensures due process of law by requiring states to end payment suspensions where an investigation has ended after 18 months, and it requires states to establish an appeal process for providers to challenge charges against them.”

New Mexico Medicaid fraud allegations mostly unfounded

The legislation comes from the debacle in New Mexico three years ago when officials with the Human Services Department (HSD) stopped Medicaid payments to 15 behavioral health providers due to “credible allegations of fraud” which disrupted care to many vulnerable state residents.

The First Judicial Court of New Mexico also ruled that HSD violated the due process rights of several of the providers when it withheld payments indefinitely, without a chance to appeal the state’s decision.

Texas experience similar to that of New Mexico

This legislation if passed will benefit Texas dental Medicaid providers who faced a similar debacle from allegations of massive dental Medicaid fraud for dental and orthodontic treatment back in 2011 with dental practices harmed severely from the “credible allegation of fraud” payment holds. Some went bankrupt.

This is of course what started TDMR.

Need we repeat that these allegations were trumped up but resulted in thousands of Texas youth under orthodontic treatment left hanging unfairly. They were the true victims.

Federal action is welcome

That federal politicians have taken action on behalf of Medicaid providers is a very welcome development.